Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HCHG FOOT PORT, 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73620
Hospital Charge Code	H3200410
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG FOREARM 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73090
Hospital Charge Code	H3200412
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$56.28

HCHG FOREARM 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73090
Hospital Charge Code	H3200412
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG FOREARM PORT 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73090
Hospital Charge Code	H3200414
Hospital Revenue Code	320
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$309.40
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: MDX Hawaii PPO	$461.72

HCHG FOREARM PORT 2 VIEWS

Facility

$476.00

Service Code	HCPCS 73090
Hospital Charge Code	H3200414
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$102.81
Rate for Payer: AlohaCare Medicare	$102.81
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$113.09
Rate for Payer: Hawaii Medical Service Association ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$102.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$102.81
Rate for Payer: Kaiser Permanente Commercial	$299.88
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$102.81
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$113.09
Rate for Payer: Ohana Health Plan Medicare	$102.81
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$102.81
Rate for Payer: University Health Alliance Commercial	$56.28

HCHG FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING

Facility

$1,410.00

Service Code	HCPCS 54450
Hospital Charge Code	H4501079
Hospital Revenue Code	450
Min. Negotiated Rate	$295.16
Max. Negotiated Rate	$2,833.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Cash Price	$916.50
Rate for Payer: Cash Price	$916.50
Rate for Payer: Cash Price	$916.50
Rate for Payer: Devoted Health Medicare	$324.68
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,339.50
Rate for Payer: Health Management Network Commercial	$1,198.50
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Commercial	$888.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: MDX Hawaii PPO	$1,367.70
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicare	$295.16
Rate for Payer: University Health Alliance Commercial	$1,027.75

HCHG FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING

Facility

$1,410.00

Service Code	HCPCS 54450
Hospital Charge Code	H4501079
Hospital Revenue Code	450
Min. Negotiated Rate	$1,198.50
Max. Negotiated Rate	$1,367.70
Rate for Payer: Cash Price	$916.50
Rate for Payer: Health Management Network Commercial	$1,198.50
Rate for Payer: MDX Hawaii PPO	$1,367.70

HCHG FROZEN SECTION

Facility

$541.00

Service Code	HCPCS 88331
Hospital Charge Code	H3120140
Hospital Revenue Code	312
Min. Negotiated Rate	$15.63
Max. Negotiated Rate	$524.77
Rate for Payer: AlohaCare Medicaid	$201.27
Rate for Payer: AlohaCare Medicare	$201.27
Rate for Payer: Cash Price	$351.65
Rate for Payer: Cash Price	$351.65
Rate for Payer: Devoted Health Medicare	$221.40
Rate for Payer: Hawaii Medical Service Association ABD	$15.63
Rate for Payer: Hawaii Medical Service Association Commercial	$251.59
Rate for Payer: Hawaii Medical Service Association Medicare	$201.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.97
Rate for Payer: Hawaii Western Management Group Commercial	$201.27
Rate for Payer: Health Management Network Commercial	$459.85
Rate for Payer: Humana Medicare	$201.27
Rate for Payer: Kaiser Permanente Commercial	$340.83
Rate for Payer: Kaiser Permanente Medicaid	$275.91
Rate for Payer: Kaiser Permanente Medicare	$201.27
Rate for Payer: MDX Hawaii PPO	$524.77
Rate for Payer: Ohana Health Plan Medicaid	$221.40
Rate for Payer: Ohana Health Plan Medicare	$201.27
Rate for Payer: UnitedHealthcare Medicaid	$15.63
Rate for Payer: UnitedHealthcare Medicare	$201.27
Rate for Payer: University Health Alliance Commercial	$171.09

HCHG FROZEN SECTION

Facility

$541.00

Service Code	HCPCS 88331
Hospital Charge Code	H3120140
Hospital Revenue Code	312
Min. Negotiated Rate	$459.85
Max. Negotiated Rate	$524.77
Rate for Payer: Cash Price	$351.65
Rate for Payer: Health Management Network Commercial	$459.85
Rate for Payer: MDX Hawaii PPO	$524.77

HCHG FSH LEVEL

Facility

$229.00

Service Code	HCPCS 83001
Hospital Charge Code	H3010624
Hospital Revenue Code	301
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$222.13
Rate for Payer: AlohaCare Medicaid	$18.58
Rate for Payer: AlohaCare Medicare	$18.58
Rate for Payer: Cash Price	$148.85
Rate for Payer: Cash Price	$148.85
Rate for Payer: Devoted Health Medicare	$20.44
Rate for Payer: Hawaii Medical Service Association ABD	$25.69
Rate for Payer: Hawaii Medical Service Association Commercial	$23.23
Rate for Payer: Hawaii Medical Service Association Medicare	$18.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.97
Rate for Payer: Hawaii Western Management Group Commercial	$18.58
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Humana Medicare	$18.58
Rate for Payer: Kaiser Permanente Commercial	$144.27
Rate for Payer: Kaiser Permanente Medicaid	$116.79
Rate for Payer: Kaiser Permanente Medicare	$18.58
Rate for Payer: MDX Hawaii PPO	$222.13
Rate for Payer: Ohana Health Plan Medicaid	$20.44
Rate for Payer: Ohana Health Plan Medicare	$18.58
Rate for Payer: UnitedHealthcare Medicaid	$25.69
Rate for Payer: UnitedHealthcare Medicare	$18.58
Rate for Payer: University Health Alliance Commercial	$48.04

HCHG FSH LEVEL

Facility

$229.00

Service Code	HCPCS 83001
Hospital Charge Code	H3010624
Hospital Revenue Code	301
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$148.85
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: MDX Hawaii PPO	$222.13

HCHG FTA ABSORPTION 90

Facility

$172.00

Service Code	HCPCS 86780
Hospital Charge Code	H3020514
Hospital Revenue Code	302
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$13.24
Rate for Payer: AlohaCare Medicare	$13.24
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$14.56
Rate for Payer: Hawaii Medical Service Association ABD	$18.97
Rate for Payer: Hawaii Medical Service Association Commercial	$16.55
Rate for Payer: Hawaii Medical Service Association Medicare	$13.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.22
Rate for Payer: Hawaii Western Management Group Commercial	$13.24
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$13.24
Rate for Payer: Kaiser Permanente Commercial	$108.36
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$13.24
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$14.56
Rate for Payer: Ohana Health Plan Medicare	$13.24
Rate for Payer: UnitedHealthcare Medicaid	$18.97
Rate for Payer: UnitedHealthcare Medicare	$13.24
Rate for Payer: University Health Alliance Commercial	$35.09

HCHG FTA ABSORPTION 90

Facility

$172.00

Service Code	HCPCS 86780
Hospital Charge Code	H3020514
Hospital Revenue Code	302
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: MDX Hawaii PPO	$166.84

HCHG FULL TRAUMA ACTIVATION W/O CC

Facility

$4,645.00

Hospital Charge Code	K6830001
Hospital Revenue Code	683
Min. Negotiated Rate	$2,368.95
Max. Negotiated Rate	$4,505.65
Rate for Payer: Cash Price	$3,019.25
Rate for Payer: Hawaii Western Management Group Commercial	$4,412.75
Rate for Payer: Health Management Network Commercial	$3,948.25
Rate for Payer: Kaiser Permanente Commercial	$2,926.35
Rate for Payer: Kaiser Permanente Medicaid	$2,368.95
Rate for Payer: MDX Hawaii PPO	$4,505.65
Rate for Payer: University Health Alliance Commercial	$3,385.74

HCHG FULL TRAUMA ACTIVATION W/O CC

Facility

$4,645.00

Hospital Charge Code	K6830001
Hospital Revenue Code	683
Min. Negotiated Rate	$3,948.25
Max. Negotiated Rate	$4,505.65
Rate for Payer: Cash Price	$3,019.25
Rate for Payer: Health Management Network Commercial	$3,948.25
Rate for Payer: MDX Hawaii PPO	$4,505.65

HCHG FUNCTIONAL LUNG VOLUME

Facility

$424.00

Service Code	HCPCS 94727
Hospital Charge Code	H4600112
Hospital Revenue Code	460
Min. Negotiated Rate	$360.40
Max. Negotiated Rate	$411.28
Rate for Payer: Cash Price	$275.60
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: MDX Hawaii PPO	$411.28

HCHG FUNCTIONAL LUNG VOLUME

Facility

$424.00

Service Code	HCPCS 94727
Hospital Charge Code	H4600112
Hospital Revenue Code	460
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$411.28
Rate for Payer: AlohaCare Medicaid	$255.08
Rate for Payer: AlohaCare Medicare	$255.08
Rate for Payer: Cash Price	$275.60
Rate for Payer: Cash Price	$275.60
Rate for Payer: Devoted Health Medicare	$280.59
Rate for Payer: Hawaii Medical Service Association ABD	$20.65
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$255.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.66
Rate for Payer: Hawaii Western Management Group Commercial	$402.80
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: Humana Medicare	$255.08
Rate for Payer: Kaiser Permanente Commercial	$267.12
Rate for Payer: Kaiser Permanente Medicaid	$216.24
Rate for Payer: Kaiser Permanente Medicare	$255.08
Rate for Payer: MDX Hawaii PPO	$411.28
Rate for Payer: Ohana Health Plan Medicaid	$280.59
Rate for Payer: Ohana Health Plan Medicare	$255.08
Rate for Payer: UnitedHealthcare Medicaid	$20.65
Rate for Payer: UnitedHealthcare Medicare	$255.08
Rate for Payer: University Health Alliance Commercial	$309.05

HCHG FUNGAL AB ADDL

Facility

$150.00

Service Code	HCPCS 86671
Hospital Charge Code	H3020899
Hospital Revenue Code	302
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

HCHG FUNGAL AB ADDL

Facility

$150.00

Service Code	HCPCS 86671
Hospital Charge Code	H3020899
Hospital Revenue Code	302
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$12.25
Rate for Payer: AlohaCare Medicare	$12.25
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Devoted Health Medicare	$13.47
Rate for Payer: Hawaii Medical Service Association ABD	$16.95
Rate for Payer: Hawaii Medical Service Association Commercial	$15.31
Rate for Payer: Hawaii Medical Service Association Medicare	$12.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.80
Rate for Payer: Hawaii Western Management Group Commercial	$12.25
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$12.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$12.25
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$13.47
Rate for Payer: Ohana Health Plan Medicare	$12.25
Rate for Payer: UnitedHealthcare Medicaid	$16.95
Rate for Payer: UnitedHealthcare Medicare	$12.25
Rate for Payer: University Health Alliance Commercial	$31.69

HCHG FUNGAL AB INITIAL

Facility

$150.00

Service Code	HCPCS 86671
Hospital Charge Code	H3020898
Hospital Revenue Code	302
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

HCHG FUNGAL AB INITIAL

Facility

$150.00

Service Code	HCPCS 86671
Hospital Charge Code	H3020898
Hospital Revenue Code	302
Min. Negotiated Rate	$12.25
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$12.25
Rate for Payer: AlohaCare Medicare	$12.25
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Devoted Health Medicare	$13.47
Rate for Payer: Hawaii Medical Service Association ABD	$16.95
Rate for Payer: Hawaii Medical Service Association Commercial	$15.31
Rate for Payer: Hawaii Medical Service Association Medicare	$12.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.80
Rate for Payer: Hawaii Western Management Group Commercial	$12.25
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$12.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$12.25
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$13.47
Rate for Payer: Ohana Health Plan Medicare	$12.25
Rate for Payer: UnitedHealthcare Medicaid	$16.95
Rate for Payer: UnitedHealthcare Medicare	$12.25
Rate for Payer: University Health Alliance Commercial	$31.69

HCHG FUNGAL DETECT BY PCR SO

Facility

$1,209.00

Service Code	HCPCS 87801
Hospital Charge Code	K3060046
Hospital Revenue Code	306
Min. Negotiated Rate	$58.84
Max. Negotiated Rate	$1,172.73
Rate for Payer: AlohaCare Medicaid	$70.20
Rate for Payer: AlohaCare Medicare	$70.20
Rate for Payer: Cash Price	$785.85
Rate for Payer: Cash Price	$785.85
Rate for Payer: Devoted Health Medicare	$77.22
Rate for Payer: Hawaii Medical Service Association ABD	$58.84
Rate for Payer: Hawaii Medical Service Association Commercial	$87.75
Rate for Payer: Hawaii Medical Service Association Medicare	$70.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$96.95
Rate for Payer: Hawaii Western Management Group Commercial	$70.20
Rate for Payer: Health Management Network Commercial	$1,027.65
Rate for Payer: Humana Medicare	$70.20
Rate for Payer: Kaiser Permanente Commercial	$761.67
Rate for Payer: Kaiser Permanente Medicaid	$616.59
Rate for Payer: Kaiser Permanente Medicare	$70.20
Rate for Payer: MDX Hawaii PPO	$1,172.73
Rate for Payer: Ohana Health Plan Medicaid	$77.22
Rate for Payer: Ohana Health Plan Medicare	$70.20
Rate for Payer: UnitedHealthcare Medicaid	$58.84
Rate for Payer: UnitedHealthcare Medicare	$70.20
Rate for Payer: University Health Alliance Commercial	$181.43

HCHG FUNGAL DETECT BY PCR SO

Facility

$1,209.00

Service Code	HCPCS 87801
Hospital Charge Code	K3060046
Hospital Revenue Code	306
Min. Negotiated Rate	$1,027.65
Max. Negotiated Rate	$1,172.73
Rate for Payer: Cash Price	$785.85
Rate for Payer: Health Management Network Commercial	$1,027.65
Rate for Payer: MDX Hawaii PPO	$1,172.73

HCHG FUNGAL ID YEAST

Facility

$175.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060188
Hospital Revenue Code	306
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$10.32
Rate for Payer: AlohaCare Medicare	$10.32
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$11.35
Rate for Payer: Hawaii Medical Service Association ABD	$14.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12.90
Rate for Payer: Hawaii Medical Service Association Medicare	$10.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.98
Rate for Payer: Hawaii Western Management Group Commercial	$10.32
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$10.32
Rate for Payer: Kaiser Permanente Commercial	$110.25
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$10.32
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$11.35
Rate for Payer: Ohana Health Plan Medicare	$10.32
Rate for Payer: UnitedHealthcare Medicaid	$14.27
Rate for Payer: UnitedHealthcare Medicare	$10.32
Rate for Payer: University Health Alliance Commercial	$26.68

HCHG FUNGAL ID YEAST

Facility

$175.00

Service Code	HCPCS 87106
Hospital Charge Code	H3060188
Hospital Revenue Code	306
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: MDX Hawaii PPO	$169.75

Know your out-of-pocket cost for care.

All Charges